多发性颅内动脉瘤夹闭术的麻醉体会

颅内动脉瘤是由于脑血管异常改变产生的脑血管瘤样突起,其主要症状多由于出血引起,部分因瘤体压迫及动脉痉挛造成。单个颅内动脉瘤瘤颈夹闭手术是神经外科难度较高、风险较大的手术。围手术期动脉瘤破裂出血的发生率为1%～2%,动脉瘤一旦破裂出血常使患者致残或死亡,     

颅内动脉瘤破裂出血急性期的外科综合治疗

目的通过对颅内动脉瘤破裂出血急性期的外科治疗,就其动脉瘤破裂急性期的治疗方法、围手术期处理和治疗策略进行探讨。方法对100例颅内动脉瘤破裂出血患者在发病3d内选择可控性微弹簧圈栓塞颅内囊性动脉瘤,带膜支架置入治疗梭形动脉瘤、宽颈动脉瘤或巨大动脉瘤以及显微手术夹闭。术后采用脑脊液引流等方法,积极治疗引起脑血管痉挛的病因,防止脑血管痉挛和脑出血。结果 100例颅内动脉瘤破裂出血患者,介入栓塞治疗72例,显微手术夹闭28例。术后98例临床痊愈,其治疗结果根据Glasgow预后评分:Ⅰ级76例,Ⅱ级13例,Ⅲ级7例,Ⅳ级2例,Ⅴ级2例。全组死亡2例,死亡率2%。结论颅内动脉瘤破裂出血应于急性期有选择地采用最佳的外科治疗,术后治疗的策略应着重于早期处理SAH,防治脑血管痉挛(CVS)及延迟性缺血性神经功能降碍(DIND)。     

血管内介入栓塞治疗颅内动脉瘤破裂的护理

颅内动脉瘤是发生在颅内动脉管壁上的异常膨出,是造成蛛网膜下腔出血的首位原因,颅内动脉瘤破裂而引起蛛网膜下腔出血的死亡率约20%～30%[1].其传统手术方法是开颅直接行动脉夹闭,手术创伤大、术后并发症多、恢复慢.血管内栓塞是近年来临床上常用于治疗颅内动脉瘤的技术,具有微创、损伤小等优点.我院自2009年应用血管内介入栓塞治疗颅内动脉瘤破裂患者30例,围手术期给予精心细致的护理,效果满意,现报告如下.     

手术夹闭动脉瘤颈治疗颅内动脉瘤破裂出血的实践研究

<正>颅内动脉瘤是神经外科的常见病,是指颅内动脉管壁上出现的异常膨出,并不是实际意义上的瘤体,多为囊状或者梭形。颅内动脉瘤破裂出血是造成蛛网膜下腔出血的首要原因,在脑血管意外中的构成比较高,对患者的神经功能造成极大的损害,同时也严重影响患者的生命安全~([1])。在颅内动脉瘤破裂出血患者中采取科学合理的治疗方案有助于获得理想的预后,而手术夹闭动脉瘤颈和介入疗法均是此类患者目     

CT与MRI在颅内动脉瘤诊断应用的研究进展

颅内动脉瘤是神经外科常见疾病,是自发性蛛网膜下腔出血最常见的病因。每年颅内动脉瘤破裂的发生率8/10万左右,颅内动脉瘤破裂出血非常凶险,死亡率和残废率非常高[1],其主要症状多由出血引起,部分因瘤体压迫、动脉痉挛及栓塞造成,常致患者残废和死亡[2]。文献[3]报告未经治疗的     

颅内破裂动脉瘤患者手术时机选择的临床分析

目的：探讨颅内破裂动脉瘤患者的手术时机与患者的手术效果及预后关系。方法：对本院2010年7月～2015年6月手术治疗的251例颅内破裂动脉瘤患者进行回顾性分析,根据患者起病至手术时间分为早期组（颅内动脉瘤破裂出血后3d内手术）63例、中期组（颅内动脉瘤破裂出血后4～10d进行手术）89例、晚期组（颅内动脉瘤破裂出血后>10d手术）99例,并根据患者入院时的Hunt-Hess分级进行亚组分析。结果：早期组患者预后良好48例（76.19%）、中期组预后良好52例（58.43%）、晚期组预后良好40例（40.40%）,早期组的预后良好率显著的高于中期组和晚期组患者,中期组患者的预后良好率显著的优于晚期组患者。对于Hunt-HessⅠ级、Ⅱ级、Ⅲ级的颅内破裂动脉瘤患者,早期组的预后良好率显著的高于中期组和晚期组患者,中期组患者的预后良好率与晚期组患者差异无统计学意义。对于Hunt-Hess IV级、V级的颅内破裂动脉瘤患者,早期组、中期组的预后良好率显著的高于晚期组患者,早期组和中期组患者的预后良好率差异无统计学意义;早期组发生脑积水率1.59%、中期组发生脑积水率3.37%均显著的低于晚期组患者的12.12%。结论：对于颅内破裂动脉瘤患者早期进行手术治疗有利于患者的预后,是否增加患者并发动脉瘤再出血的风险需要进一步进行研究。     

颅内动脉瘤待手术期破裂再出血的危险因素及护理对策

目的:为了减少颅内动脉瘤破裂再出血的发生,给颅内动脉瘤行开颅夹闭术或栓塞术创造良好时机,提高病人的生存质量。方法:回顾分析我科2005~2007年收治的75例颅内动脉瘤病人的护理资料,结合相关文献探讨护理对策。结果:75例患者中8例因情绪异常、高血压、用力排便等因素造成动脉瘤破裂再出血,3例死亡,失去了治疗机会。结论:做好心理护理、控制血压、指导合理饮食、绝对卧床休息是预防动脉瘤破裂再出血的重要环节。     

电解可脱性弹簧圈栓塞治疗颅内动脉瘤的护理体会

正电解可脱性弹簧圈栓塞(GDC)是治疗颅内动脉瘤理想的栓塞材料,颅内动脉瘤是颅内动脉壁上的异常膨出,主要症状多由动脉瘤破裂出血引起,GDC治疗颅内破裂动脉瘤是一种微创、安全、效果好的新技术,可达到近似手术夹闭的效果。2008年12月至2011年8月我科应用GDC治疗颅内动脉瘤65例,通过术前、术后的病情观察和精心护理,减少了并发症的     

颅内动脉瘤破裂出血伴有血肿形成的手术治疗

【摘要】目的探讨超早期手术治疗伴有颅内血肿形成的破裂动脉瘤的可行性及临床效果。方法回顾性分析近年来本院收治的31例颅内动脉瘤破裂伴血肿形成患者的临床资料,对患者术中及术后并发症发生及预后情况进行统计。结果所选患者破裂动脉瘤最常见于大脑中动脉及前交通动脉。3l例手术患者术后15例恢复良好,13例有严重残疾,3例死亡。结论对于颅内动脉瘤破裂出血伴有颅内血肿形成的患者,超早期手术清除血肿并夹闭动脉瘤能够获得较为满意的临床效果。     

急诊3D-CTA对破裂性颅内动脉瘤的临床诊断价值

目的探讨64排容积CT血管造影(CTA)及3D重建在急性颅内动脉瘤破裂出血诊疗中的临床应用价值。方法回顾性分析143例颅内动脉瘤破裂出血患者行急诊颅脑CTA检查,并经手术治疗的影像及临床资料,对照破裂动脉瘤的3D-CTA影像表现与外科手术及介入手术所见,评价其临床应用价值。结果 143例患者中,142例手术证实为破裂动脉瘤,1例为假性动脉瘤。急诊显微外科手术成功夹闭125个破裂动脉瘤,17例行DSA介入栓塞治疗;动脉瘤分布情况:颈内动脉-后交通段动脉瘤60个,占40.54%,前交通动脉瘤及大脑前动脉瘤43个,占29.05%,大脑中动脉瘤37个,占25%,椎-基底动脉瘤8个,占5.41%。142例颅内破裂动脉瘤影像所见大小、形态及位置与手术所见基本一致。结论 64排容积CT血管造影及3D重建在急诊颅内动脉瘤破裂出血诊断中具有准确、简便、快速及无创的优点,CTA-VR、MPR显示瘤体及载瘤动脉的三维立体图像,对临床确定手术入路及手术方式具有重要的参考价值。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.